JoVE Journal > Medicine
Summary
Abstract
Introduction
Protocol
Résultats
Discussion
Divulgations
Acknowledgements
Materials
References
Traduction automatique
Please note that all translations are automatically generated. Click here for the English version.
Médecine

穴位嵌入联合熨烫治疗肛门术后疼痛

Published: June 23, 2023
doi:
10.3791/64852
, ,
1Hospital of Chengdu University of Traditional Chinese Medicine, 2Chengdu University of Traditional Chinese Medicine

Summary

肛门手术后疼痛的高发生率是由于肛门的生理结构和病理状态。目前，使用止痛药不能提供令人满意的疼痛缓解，这使得补充治疗很重要。本文提出穴位嵌入结合熨烫疗法缓解术后疼痛。

Abstract

穴位嵌入结合熨烫疗法是一种非药物治疗方法，可缓解肛门手术后疼痛。该实践以中医（TCM）综合征鉴别理论为指导，采用穴位刺激和加热来缓解疼痛。尽管先前的研究表明这些是缓解疼痛的可靠方法，但尚未描述这两种技术的综合效果。在我们的研究中，我们发现，与单独使用双氯芬酸钠肠溶胶囊相比，增加穴位针嵌入结合熨烫疗法对减轻痔疮手术后不同阶段的疼痛程度更有效。尽管这种技术是有效的，并且通常用于诊所，但由于其侵入性实践，穴位针嵌入仍然存在与医院获得性感染和断针相关的风险。另一方面，熨烫疗法可能导致烧伤和结缔组织损伤。因此，迫切需要为医务人员制定标准化的协议。我们的方案完善了传统技术，并提供有关患者准备、手术技术和术后护理的详细说明，以确保治疗安全有效地进行。通过标准化这种疗法，该技术有望成为缓解痔疮术后疼痛的重要补充疗法，这将显着改善患者肛门手术后的生活质量。

Introduction

术后疼痛是肛门直肠手术中最常见的并发症之一。在这些疾病中，痔疮手术引起的疼痛尤为普遍1。一般来说，术后疼痛可能是由于术后焦虑引起的2、手术方法不当3、血液和淋巴流动受阻4、手术伤口感染、肛门内括约肌痉挛5.在大多数情况下，术后疼痛是正常的生理反应，但过度或持续的疼痛会给患者带来不适，加重心理压力，从而阻碍康复6。

对于轻度疼痛，非类固醇抗炎药（NSAIDs），钙通道阻滞剂和表面麻醉剂可以满足治疗要求7,8。对于剧烈疼痛，吗啡和曲马多似乎是合适的选择9。然而，镇痛药与肛门直肠手术中疼痛缓解效果差有关，非甾体抗炎药引起的消化道出血或胃溃疡的风险使临床医生犹豫是否开处方10,11。此外，阿片类药物的成瘾性会对患者的生活水平产生巨大影响12。优化手术程序以预防术后疼痛，例如包括肛门内括约肌切开术，由于其肛门失禁的风险而受到批评13。

穴位针包埋是针灸治疗的一个分支，其镇痛作用早已得到认可。Ashi穴位具有良好的镇痛效果，但由于肛门的生理功能和解剖结构，其实践受到限制，因为直接刺激肛门只会增加患者的疼痛14。近年来，刺激其他穴位释放疼痛已有报道15,16。Wang等人17通过用杵针刺激长强（DU1）、成山（BL57）和二白（EX-UE2）等穴位，在痔疮手术后取得了显著的止痛效果。一项更全面的研究发现，假针灸组在治疗后5 h、7 h和8 h的疼痛缓解低于针灸刺激组18。同时，根据几项荟萃分析，刺激穴位可以减轻术后疼痛，治疗效果优于非甾体抗炎药19,20。在中医理论中，刺激穴位可以减轻患者的焦虑状态。此外，它还可以促进局部血液循环，加速炎症的消退和组织修复17。有研究报道，针灸还可以促进脑啡肽和内啡肽等内源性镇痛物质的释放，阻断疼痛信号在神经细胞中的传递21。针灸治疗不仅能有效缓解痔疮术后疼痛，而且据报道，它还能有效缓解肌肉骨骼疼痛22、背痛23和原发性痛经24。总结以往的临床试验，我们认为穴位刺激对缓解痔疮术后疼痛是有效的。

熨烫疗法是人类历史上使用最广泛的治疗方法之一。它涉及利用热量穿透皮肤并加速血液流动，促进组织新陈代谢，并调节感觉神经以减轻疼痛25。此外，热量还可以缓解肌肉的收缩26。按摩技术可以添加到这种治疗中，以增加缓解疼痛的效果。先前的一项临床试验表明，在耻骨上和骶骨区域按摩可以缓解会阴区域的疼痛27。它的工作原理是阻止疼痛信号到达中枢神经系统，同时增加交感神经活动并减轻负面情绪引起的疼痛28,29。

协议中包含的操作程序提高了手术的安全性，缩短了住院天数，降低了术后疼痛程度，并降低了尿潴留和肛门水肿的发生率。穴位嵌入结合熨烫治疗是治疗痔疮术后疼痛的特色中医方法，推荐给无禁忌症的健康成年人。有望成为术后疼痛患者的重要补充治疗。

Protocol

该协议的简要图形流程如图 1 所示。该方案按照《赫尔辛基宣言》进行，方案得到成都中医药大学医院（代码：470000013,4300000011）的批准。数据是在患者的知情同意下获得的。患者在研究前自愿签署知情同意书。纳入标准如下：遵循医生建议的能力;签署同意书;痔疮的诊断;用Milligan-Morgan手术切除痔疮（M-M手术）。排除标准如下：患有严重器官疾病的患者;患有焦虑、抑郁或其?…

Representative Results

统计分析使用 SPSS 22.0 收集和分析数据。在这项工作中，正态分布连续变量表示为平均±标准（SD），并使用学生t检验对两组进行比较。使用中位数和25%和75%的四分位距M（QL，QU）描述具有偏态分布的连续变量，并使用Mann-Whitney U检验进行组间比较。使用卡方检验检验二分类变量。 p < 0.05 的值被认为具有统计学意义。 结果选取2022年8月至202…

Discussion

痔疮的外科手术发展迅速。除了传统的M-M手术外，橡皮筋结扎术（RBL）、脱垂和痔疮（PPH）、组织选择治疗吻合器（TST）、痔动脉结扎术和红外光凝术等手术也得到了广泛的应用37,38,39。然而，M-M手术的优点，如治愈率高，价格低，操作简单，使其成为当今最常用的手术之一40。作为最敏感的器官之一，肛门?…

Divulgations

The authors have nothing to disclose.

Acknowledgements

本研究得到了成都中医药大学附属医院基金会（Y2023016）和成都中医药大学临床医学院第二届研究生研究创新实践项目（LCYJSKT2023-35）和四川省中医药管理局全科计划（2023MS005）的支持。

Materials

diclofenac sodium enteric-coated capsules Temmler Ireland Co., Ltd., Kerry, Ireland H20170098
fructus aurantii Traditional Chinese Medicine Co., Ltd., Sichuan, China 220209
fructus foeniculi Traditional Chinese Medicine Co., Ltd., Sichuan, China 220210
gauze bag Anhui Meijianan Household Products Co., Ltd, Anhui, China M921
hand sanitizer Suolang Medical Disinfectants Co., Ltd., Zhejiang, China 200561121Q
iodophor cotton swabs Jiabeier Medical Technology Co., Ltd., Zhejiang, China 20162140536
microwave oven Galanz Group Co., Ltd., Guangdong, China P70D20L-ED(W0)
press needle Suzhou Acupuncture Supplies Co., Ltd. Zhejiang, China 20162200591
pulverizer Zhaofenger Industry and Trade Co., Ltd., Hunan, China J80031
radix paeoniae alba Guoqiang Pharmaceutical Co., Ltd., Sichuan, China 220601
rhizoma chuanxiong Yuankang Pharmaceutical Co., Ltd., Sichuan, China 220603
rhizoma corydalis Xinhehua Pharmaceutical Co., Ltd., Sichuan, China 2206071
rhizoma curcumae longae Traditional Chinese Medicine Co., Ltd., Sichuan, China 220216
sterile cotton swabs Zhongxin Sanitary Materials Co., Ltd., Sichuan, China 20180021
sterile tweezers Weigao Grope Medical Polymer Co., Ltd., Shandong, China 20182640148
thermometer Beierkang Medical Devices Co., Ltd., Guangdong, China 20162200505
treatment towel Sichuan Hualikang Medical Technology Co., Ltd, Sichuan, China 2111901
DOWNLOAD MATERIALS LIST

References

  1. Hollingshead, J. R., Phillips, R. K. Haemorrhoids: Modern diagnosis and treatment. Postgraduate Medical Journal. 92 (1083), 4-8 (2016).
  2. Li, X. R., et al. A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations. Journal of Psychosomatic Research. 147, 110528 (2021).
  3. Menconi, C., et al. Anal and pelvic floor pain after PPH and STARR: Surgical management of the fixed scar staple line. International Journal of Colorectal Disease. 31 (1), 41-44 (2016).
  4. Rabelo, F. E. F., et al. Benefits of flavonoid and metronidazole use after excisional hemorrhoidectomy: A randomized double-blind clinical trial. Techniques in Coloproctology. 25 (8), 949-955 (2021).
  5. Hite, M., Curran, T. Biofeedback for pelvic floor disorders. Clinics in Colon and Rectal Surgery. 34 (1), 56-61 (2021).
  6. Balciscueta, Z., Balciscueta, I., Uribe, N. Post-hemorrhoidectomy pain: Can surgeons reduce it? A systematic review and network meta-analysis of randomized trials. International Journal of Colorectal Disease. 36 (12), 2553-2566 (2021).
  7. Linares-Gil, M. J., et al. Topical analgesia with lidocaine plus diclofenac decreases pain in benign anorectal surgery: Randomized, double-blind, and controlled clinical trial. Clinical and Translational Gastroenterology. 9 (11), 210 (2018).
  8. Yadav, S., Khandelwal, R. G., Om, P., Ravindra, K., Choudhary, K. L. A prospective randomized double-blind study of pain control by topical calcium channel blockers versus placebo after Milligan-Morgan hemorrhoidectomy. International Journal of Colorectal Disease. 33 (7), 895-899 (2018).
  9. Leinicke, J. A., et al. Opioid prescribing patterns after anorectal surgery. Journal of Surgical Research. 255, 632-640 (2020).
  10. Stessel, B., et al. Metamizole vs. ibuprofen at home after day case surgery: A double-blind randomised controlled noninferiority trial. European Journal of Anaesthesiology. 36 (5), 351-359 (2019).
  11. Kroenke, K., Cheville, A. Management of chronic pain in the aftermath of the opioid backlash. JAMA. 317 (23), 2365-2366 (2017).
  12. Leinicke, J. A., et al. Opioid prescribing patterns after anorectal surgery. Journal of Surgical Research. 255, 632-640 (2020).
  13. Lohsiriwat, V., Jitmungngan, R. Strategies to reduce post-hemorrhoidectomy pain: A systematic review. Medicina. 58 (3), 418 (2022).
  14. Mitidieri, A. M. S., et al. Ashi acupuncture versus local anesthetic trigger point injections in the treatment of abdominal myofascial pain syndrome: A randomized clinical trial. Pain Physician. 23 (5), 507-518 (2020).
  15. Long, Q., et al. Clinical observation of electroacupuncture combined with auricular point sticking therapy for anal pain of mixed hemorrhoid after external excision and internal ligation. Zhongguo Zhen Jiu. 38 (6), 580-585 (2018).
  16. Yeh, M. L., Chung, Y. C., Hsu, L. C., Hung, S. H. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: A randomized-controlled study. Clinical Nursing Research. 27 (4), 450-466 (2018).
  17. Wang, X., et al. Effects of the pestle needle therapy, a type of acupoint stimulation, on post-hemorrhoidectomy pain: A randomized controlled trial. Journal of Integrative Medicine. 18 (6), 492-498 (2020).
  18. Wu, J., et al. Effect of acupuncture on post-hemorrhoidectomy pain: A randomized controlled trial. Journal of Pain Research. 11, 1489-1496 (2018).
  19. Ye, S., Zhou, J., Guo, X., Jiang, X. Three acupuncture methods for postoperative pain in mixed hemorrhoids: A systematic review and network meta-analysis. Computational and Mathematical Methods in. 2022, 5627550 (2022).
  20. Du, B., Xu, Z., Zhong, X. Electroacupuncture for postoperative pain in mixed hemorrhoids: A meta-analysis. Médecine. 101 (50), e32247 (2022).
  21. Patil, S., et al. The role of acupuncture in pain management. Current Pain and Headache Reports. 20 (4), 22 (2016).
  22. Yuan, Q. L., et al. Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports. 6, 30675 (2016).
  23. Mu, J., et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database of Systematic Reviews. 12 (12), (2020).
  24. Woo, H. L., et al. The efficacy and safety of acupuncture in women with primary dysmenorrhea: A systematic review and meta-analysis. Médecine. 97 (23), 11007 (2018).
  25. Zhang, Y. Y., et al. Traditional Chinese nursing using fennel with coarse salt for ironing and umbilical moxibustion for epigastric pain with spleen-stomach vacuity cold. Alternative Therapies in Health and Medicine. 28 (7), 88-94 (2022).
  26. Lei, J., Ye, G., Wu, J. T., Pertovaara, A., You, H. J. Role of capsaicin- and heat-sensitive afferents in stimulation of acupoint-induced pain and analgesia in humans. Neurosciences. 358, 325-335 (2017).
  27. Ying, J., et al. Effect of essential oil on patients with chronic prostatitis/chronic pelvic pain syndrome: A pilot randomized controlled trial. Chinese Journal of Integrative Medicine. 25 (2), 91-95 (2019).
  28. Bauer, B. A., Tilburt, J. C., Sood, A., Li, G. X., Wang, S. H. Complementary and alternative medicine therapies for chronic pain. Chinese Journal of Integrative Medicine. 22 (6), 403-411 (2016).
  29. Hatayama, T., Kitamura, S., Tamura, C., Nagano, M., Ohnuki, K. The facial massage reduced anxiety and negative mood status, and increased sympathetic nervous activity. Biomedical Research. 29 (6), 317-320 (2008).
  30. Sarwar, S., Muhammad, J., Shahzad, F. A modified hand washing method for resource limited settings. Frontiers in Public Health. 10, 965853 (2022).
  31. Yeh, M. L., Chung, Y. C., Hsu, L. C., Hung, S. H. Effect of transcutaneous acupoint electrical stimulation on post-hemorrhoidectomy-associated pain, anxiety, and heart rate variability: A randomized-controlled study. Clinical Nursing Research. 27 (4), 450-466 (2018).
  32. Rizk, C., Monroe, H., Orengo, I., Rosen, T. Needlestick and sharps injuries in dermatologic surgery: A review of preventative techniques and post-exposure protocols. Journal of Clinical and Aesthetic Dermatology. 9 (10), 41-49 (2016).
  33. Li, Z. M., Chen, J. Y., Sun, S., Ming, R. K., Wu, S. Brief analysis on pivot effect of Tianshu (ST 25). Zhongguo Zhen Jiu. 40 (12), 1319-1321 (2020).
  34. Linares-Gil, M. J., et al. Topical analgesia with lidocaine plus diclofenac decreases pain in benign anorectal surgery: Randomized, double-blind, and controlled clinical trial. Clinical and Translational Gastroenterology. 9 (11), 210 (2018).
  35. Park, H. J., et al. A comparison between directional and proportional methods in locating acupuncture points using dual-energy X-ray absorptiometry in Korean women. American Journal of Chinese Medicine. 34 (5), 749-757 (2006).
  36. Godson, D. R., Wardle, J. L. Accuracy and precision in acupuncture point location: A critical systematic review. Journal of Acupuncture and Meridian Studies. 12 (2), 52-66 (2019).
  37. Jia, X. Q., et al. Effect of high suspension and low incision surgery based on traditional ligation of Chinese medicine in treatment of mixed haemorrhoids: A multicentre, randomized, single-blind, non-inferiority clinical trial. Chinese Journal of Integrative Medicine. 27 (9), 649-655 (2021).
  38. Mott, T., Latimer, K., Edwards, C. Hemorrhoids: Diagnosis and treatment options. American Family Physician. 97 (3), 172-179 (2018).
  39. Wang, T. H., Kiu, K. T., Yen, M. H., Chang, T. C. Comparison of the short-term outcomes of using DST And PPH staplers in the treatment of grade III and IV hemorrhoids. Scientific Reports. 10 (1), 5189 (2020).
  40. Altomare, D. F., et al. Surgical management of haemorrhoids: An Italian survey of over 32 000 patients over 17 years. Colorectal Disease. 20 (12), 1117-1124 (2018).
  41. Boland, P. A., et al. Management options for chronic anal fissure: A systematic review of randomised controlled trials. International Journal of Colorectal Disease. 35 (10), 1807-1815 (2020).
  42. Urits, I., et al. A comprehensive review of alternative therapies for the management of chronic pain patients: Acupuncture, Tai Chi, osteopathic manipulative medicine, and chiropractic care. Advances in Therapy. 38 (1), 76-89 (2021).
  43. Vickers, A. J., et al. Acupuncture for chronic pain: Update of an individual patient data meta-analysis. Journal of Pain. 19 (5), 455-474 (2018).
  44. Sun, Y., et al. Efficacy of acupuncture for chronic prostatitis/chronic pelvic pain syndrome: A randomized trial. Annals of Internal Medicine. 174 (10), 1357-1366 (2021).
  45. Mao, J. J., et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: The PEACE randomized clinical trial. JAMA Oncology. 7 (5), 720-727 (2021).
  46. Lee, I. S., Cheon, S., Park, J. Y. Central and peripheral mechanism of acupuncture analgesia on visceral pain: A systematic review. Evidence-Based Complementary and Alternative Medicine. 2019, 1304152 (2019).

Tags

Acupoint Needle-embeddingIroning TherapyPostoperative PainAnal SurgeryHemorrhoid SurgeryPatient AssessmentDisinfectionAcupointsEX-UE2BL-57SP-6Needle InsertionNeedle RemovalIroningCV-29ST-25DU-1Drug PulverizationGauze BagMicrowave Heating

Play Video
PDF
DOI
DOWNLOAD MATERIALS LIST
Citer Cet Article
Tang, X., Kang, J., Liu, Y. Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery. J. Vis. Exp. (196), e64852, doi:10.3791/64852 (2023).
Télécharger la Citation
Réimpressions et Autorisations

View Video

✖

To prove you're not a robot, please enter the text in the image below

CAPTCHA Image
Play CAPTCHA Audio
Refresh Image